How ALL is diagnosed
Usually you will see your GP, who will examine you and take a blood test. If the results of the test are abnormal in any way, your GP or a haematologist from the local hospital will contact you.
A haematologist is a doctor who specialises in the treatment of blood problems. They will arrange for you to be seen quickly at the hospital for further tests and treatment.
You may have some of the following tests.
Most people with ALL are referred for treatment at a specialist haematology unit in the hospital. The haematologist will ask you about your general health and any previous medical problems before examining you and doing a blood test to check the numbers of all the different types of blood cell.
If the blood test shows that leukaemia cells are present, the haematologist will want to take a sample of your bone marrow. This is the most important test, because it finds out the exact type of leukaemia you have and provides information that the doctors need to plan the best treatment for you.
Bone marrow sample/biopsy
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A small sample of bone marrow is taken from the back of the hip bone (pelvis) or occasionally the breast bone (sternum). It’s looked at under a microscope to see if it contains any abnormal white blood cells. A haematologist can tell which type of leukaemia it is by identifying the type of abnormal white cell. Other tests will be carried out on the bone marrow sample to help confirm the diagnosis.
Before the bone marrow sample is taken, you’ll be given a local anaesthetic injection to numb the area. A thin needle is then passed through the skin into the bone. A small sample of the bone marrow is drawn into a syringe to be examined under a microscope. The procedure can be done on the ward or in the outpatients department, and takes about 15-20 minutes.
It can be uncomfortable when the marrow is drawn into the syringe, but this should only last for a short time. You may be offered a short-acting sedative to reduce any pain or discomfort during the test.
Sometimes a small core of marrow is needed (a trephine biopsy), and this procedure takes a few minutes longer.
A special type of needle, which is thicker than the one used to take a sample, is passed through the skin into the bone marrow. The doctor will push the biopsy needle in, turning it back and forth. When the needle is withdrawn it will contain a 1-2cm core of bone marrow.
You may feel bruised after having a sample of bone marrow taken, and have an ache for a few days. This can be eased with mild painkillers.
Each cell in the body contains chromosomes, which are made up of genes. The genes control all the activities of the cell.
In leukaemia there are often changes in the structure of the chromosomes within the leukaemic cells, but not within the normal cells of the body.
The tests on the blood and bone marrow sample will include a chromosome analysis to look for any particular changes in the chromosomes. Different types of leukaemia are associated with particular genetic changes.
These tests are known as cytogenetic tests. They can help your doctor decide the best treatment for you and predict how well you may respond to that treatment.
Another test on the blood or bone marrow sample will show which type of lymphocyte has become cancerous. This test is called immunophenotyping and can tell the doctors whether the leukaemia developed from B-lymphocytes or T-lymphocytes. Knowing which type of lymphocyte is affected helps the doctors plan the most appropriate treatment.
This is taken to check for any sign of swollen lymph glands in the chest.
A small sample of the fluid that surrounds your brain and spinal cord is taken to check for leukaemia cells. Your doctor uses a local anaesthetic to numb the lower part of your back and then passes a needle gently into the spine to draw off a tiny sample of the fluid.
Having a lumbar puncture may be uncomfortable, but it only takes a few minutes. Some people may have a headache afterwards. If this happens let your doctor know so that they can prescribe painkillers for you. You may need to lie flat for a few hours afterwards. We have more information about having a lumbar puncture.
Scans - such as a CT, MRI or ultrasound scan - may be done to find out if the leukaemia has spread to other parts of your body. Your doctor or specialist nurse can tell you about any scans that may be necessary.
It will probably take several days for the results of your tests to be ready, and this waiting period will obviously be an anxious time for you. It may help if you talk things over with a relative or close friend. You can also contact our cancer support specialists.